As in the past, the SNF Part A payment rates will be updated 10/1/2010; however, the rates you will be billing at will be temporary and eventually retroactively adjusted.  As part of The Patient Protection and Affordable Care Act enacted on March 23, 2010, changes will be made to the current RUGs system which will reflect a hybrid RUG-III (HR-III) system which incorporates RUG-IV’s specific revisions on concurrent therapy and the look-back period within the framework of the existing RUG-53 system, along with the use of MDS 3.0.  The problem exists that the HR-III system’s infrastructure might not be built and ready in time before the 10/1/2010 payment period change.  Therefore, until the infrastructure is built to bill at the HR-III rates, billing for these Part A services will need to be made based on the RUGs IV rates published in the July 22, 2010 federal register with eventual retroactive adjustments taking place to incorporate and pay providers at the HR-III rates included in the same federal register notice.  Click on link for Rugs IVand Hybrid III rates. 

UPDATE!!

 Part B Fee Schedule:  June 1, 2010 -- November 30, 2010

A week after the Senate passed “The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010” on June 18, 2010, restoring Medicare reimbursement to physicians with a 2.2 percent increase for a six-month period ending November 30, 2010, the legislation has been approved by the House and signed by the President

The Centers for Medicare and Medicaid Services expects to begin processing claims at the new rates no later than July 1, 2010.  Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible.

The new rates effective for dates of service June 1, 2010 through November 30, 2010 are posted under the Newsletters link "June 1 through November 30, 2010 Therapy Fee Schedule".  

Part B Fee Schedule:  January 1, 2010 through May 31, 2010

It is very important to note that on May 10, 2010, revised payment files for Part B claims were released to Medicare Contractors.  These revised payment files incorporated changes published in the May 5, 2010 Federal Register and changes from the Patient Protection and Affordable Health Care Act.  According to CMS, these published changes are retroactive to January 1, 2010 through May 31, 2010.  Therefore, if you previously received payments for January through April dates of service, these claims will be retroactively adjusted by your Medicare contractor.  However, it is highly advised that your billing personnel check with your Medicare contractor to determine when these adjustments will be made and when you should expect to receive the payment adjustments.  In addition, it is advised that you check your May dates of service claims to ensure you were paid based on the May 5, 2010 Correction Notice.  Refer to the attached link for “January 1 through May 31, 2010 Therapy Fee Schedule” payments.